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A revolutionary treatment involving electrical stimulation of the spine has allowed paralyzed patients to walk again, apparently reactivating nerve connections and giving hope to people even years after accidents.
A team consisting of neurosurgeons and engineers used targeted electrical impulses to get the results, triggering the muscles individually in a sequence identical to that of the brain.
The impulses are produced by an implant placed on the spine, in precise alignment with the areas that control the muscles of the lower body. And until now, the results are promising.
"This clinical trial has given me hope," said 35-year-old Gert-Jan Oskam, who was told that he would never walk again after a road accident in 2011.
After five months of treatment, he can now travel short distances even without the help of electrical stimulation.
This is the culmination of "more than a decade of extensive research," Grégoire Courtine, a neuroscientist at the Swiss Federal Institute of Technology, told AFP.
Earlier trials used what is known as continuous electrical stimulation of the spine, which worked well in rats, but produced less impressive results in humans.
After several months of targeted pulsation training, "our three participants were able to activate their previously paralyzed muscles without electrical stimulation," said Courtine.
"The result was completely unexpected," he added in a video published with the publication of the research in the journal Nature. "They could even take a few steps on the surface without any support, hands free. For me, seeing this recovery was incredible. "
The sequences of the study clearly show how targeted stimulation differs from continuous impulses. With targeted stimulation, a patient walks almost plainly, feet in the air. Continuous stimulation, on the other hand, produces a more jerky movement, the feet dragging and unbalancing it.
And the targeted pulses, combined with an intensive physiotherapy program, apparently reactivated nerve connections that became dormant when patients were injured.
David Mzee, 28, was completely paralyzed from the left leg after an accident in 2010, but after the five-month program, he can walk up to two hours with a walker using electrical stimulation or walk alone on short distances.
The stimulation starts with a pulse directed at a muscle to invite the patient to start moving, for example a step. Sensors on the feet detect movement as the initial phase of a step and send additional targeted pulses to trigger the muscle movements needed to perform the step and repeat it. At the same time, patients think about moving these muscles and walking.
Since brain neurons trigger almost exactly at the same time that electrical impulses stimulate muscles, the technique ultimately seems to "reconnect" the brain and muscles. Patients can then control muscle movement even without electrical triggers.
"It was amazing to see all these patients moving their legs without electrical stimulation," said Jocelyne Bloch, a neurosurgeon at the Lausanne University Hospital, who helped lead the study.
In an independent evaluation, Chet Moritz, an associate professor in the Department of Rehabilitation Medicine at the University of Washington, praised the work.
"The field of spinal cord injury is about to take a giant step in the treatment of what was until recently considered incurable paralysis," he wrote.
Courtine cautioned, however, that it was "very important to calibrate the expectations," noting that the three patients were still primarily dependent on their wheelchairs.
The study also focused on patients who had retained some sensation in the lower body.
Courtine said she hoped to see the technique combined with biological treatments involving nerve repair.
He and Bloch have founded a start-up that will refine the treatment and test it on people shortly after a spinal cord injury, while this technique will probably be more effective.
"There is still a lot of work to do to change the lives of these people," said Courtine.
© 2018 AFP
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